11. Nursing and Psychosocial Issues
360 Mothers’ and fathers’ depression: how much cystic ﬁbrosis (CF) or other variables affect it
362 Emotional condition in the family of child and adolescent cystic ﬁbrosis (CF) patients
P. Catastini1 , C. Lenzi1 , A. Martellacci1 , S. De Masi2 , C. Braggion1 , Psychologist Group Italian CF Society. 1 Meyer Hospital Florence University, Florence, Italy; 2 Meyer Hospital Florence University, Epidemiological Staff, Florence, Italy
P. Catastini1 , S. Gori2 , A. Martellacci2 , S. De Masi3 , C. Braggion2 , Psychologist Group Italian CF Society. 1 Meyer Hospital Florence University, Pediatric, Florence, Italy; 2 Meyer Hospital Florence University, Florence, Italy; 3 Meyer Hospital Florence University, Epidemiological Staff, Florence, Italy
Cystic Fibrosis (CF) is a multisystemic illness, its daily behaviours and therapy needs represent an emotional burden. This condition could create anxiety and anguish states expecially during exacerbations. Many studies have explored patients’ and families’ emotional state but just recently TIDES (The International Depression/anxiety Epidemiological Study) has evaluated more accurately anxiety and depression levels in patients and parents relating them to other variables. A signiﬁcant correlation between geographic area and emotional level has been evidenced by Italian data of the TIDES, suggesting the hypothesis of different psychosocial approaches depending on the location of the CF centre, to obtain a better quality of assistance and a major compliance. Aims: The study explores how and how much geographic area inﬂuences parents’ depression and anxiety levels. Methods: The HADS (Hospital Anxiety and Depression Scale) and CES-D (Centre for Epidemiological Studies − Depression Scale) were administered to 213 couples of parents of 0−11 y.o. children and 12−17 y.o. adolescents, during the follow-up. Results: A low correlation (r = 0.34) between geographic area and anxiety and depression levels of both parents has resulted. Conclusions: Peculiar cultural aspects of different Italian regions (north, centre and south) do not affect parents’ emotional conditions, validating the different psychosocial approaches actuated by every CF centre. This leads to further research to expand knowledge about which kind of variables can inﬂuence depression in addition to the current disease, in order to offer minimal standards of care that will include tailored psychological interventions.
Background: Cystic ﬁbrosis (CF) management is a signiﬁcant emotional condition for the patient’s parents. Faceing the emotional distress is linked not only to the illness state but also with personal structure and other variables. Some study in Europe and in USA evidence that the mother’s emotional state is worse than father’s. Aims: This study evaluates how and how much father’s depression level have a protective or risk role towards mother’s depression development level. Method: The sample is made of 213 couples of mothers and fathers of 0−11 and 12−17 years old CF patients. We administered the H.A.D.S. (Hospital Anxiety and Depression Scale − Zigmond and Snaith, 1983) questionnaire and the CES-D (The Centre for Epidemiological Studies-Depression Scale − Radloff, 1977) during follow-up. Results: Linear regression applied to the data of both parents shows a partial correlation between fathers’ and mothers’ total HADS scores (Correlation Coefﬁcient r = 0.35). Conclusion: Our results showed that there is a minimal correlation between father’s and mother’s depression. Therefore we think that for those future psychological supports of the family, it would be better to focus our resources previously on the individual session and to consider consequentially the couple therapy. Moreover, we think that it is important to complete our data studying the individual personal structure because since this variable is very relevant it could expand our knowledges about general depression problem suggesting accurately wich kind of interventions could have a major level of efﬁcacy in supporting mothers ability of taking care and helping their sons during life-time with illness.
361 The inﬂuence of experiential avoidance on depression, anxiety and life quality in adult cystic ﬁbrosis (CF) patients
363 Personality, psychosocial factors and illness effect on adherence behaviour in cystic ﬁbrosis (CF)
S. Schusser1 , U. Smrekar1 , J. Eder2 , T. Beck1 , H. Ellemunter2 , H. Mitmannsgruber1 . 1 Medical University of Innsbruck, Dept. of Medical Psychology, Innsbruck, Austria; 2 Medical University of Innsbruck, Cystic Fibrosis Centre, Innsbruck, Austria
M. Braithwaite1 , D. Clarke1 , S. Soﬁanopoulos1 , M. Dooley1 , F. Finlayson1 , D. Liew1 , S. Poole1 , E. Williams1 , J.W. Wilson1 . 1 Alfred Hospital, Allergy Immunology and Respiratory Medicine, Melbourne, Australia
Objectives: The aim of the study was to investigate psychological symptoms (depression and anxiety) and quality of life in adult CF patients and potential predictors (illness severity as measured by lung function, “experiential avoidance” as the avoidance of inner experience such as thoughts, emotions and physical sensations). Methods: A sample of n = 48 patients (50% female) aged between 18 and 53 years was assessed during routinely performed outpatient visits (including lung function assessment). No patient suffered from acute pulmonary exacerbation. A questionnaire was administered including the Acceptance and Action Questionnaire (AAQ), the Hospital Anxiety and Depression Scale − German Version (HADS-D) and the Cystic Fibrosis Quality of Life Questionnaire (CFQ-R). Results: Patients did not report elevated psychological symptoms compared to the general population. Illness severity had no predictive power. However, there was an association between patients’ symptoms level and the degree of experiential avoidance. Quality of life was negatively correlated with anxiety and depression. No association was found for experiential avoidance and lung function. Multiple regressions analyses revealed depression as a single signiﬁcant predictor for quality of life. Conclusion: Contrary to other ﬁndings in the TIDES-study our adult sample did not show elevated anxiety or depression. Participants seem to be remarkably resilient. However, consistent with empirical ﬁndings on experiential avoidance suppressing emotions is associated with increased psychological symptoms in adult CF patients. Depressive symptoms are of central importance for the clinical management of patients.
Adherence to treatment is inﬂuenced by many factors and is critical to optimal cystic ﬁbrosis (CF) management. Severity of disease (e.g. low FEV1 ) and illness state (eg inpatient versus outpatient) may affect subjective responses to research surveys. Aim: To explore the impact of illness effect and severity effect on adherence behaviour reporting. Methodology: Demographic and health related measures were collected in addition to a battery of self-administered and pharmacist administered questionnaires investigating personality (NEO-PI), psychosocial (depression, anxiety, social support, health locus of control, quality of life, health beliefs) and adherence behaviour (Morisky score, pharmacy pick-up) to each patient requiring an inpatient admission for an exacerbation of their CF. All tests were re-administered 4 weeks following their in-patient admission in a stable phase. Results: The study recruited 20 participants [age M = 25.8 yrs, SD = 20.7 (range 40−18 yrs)], 11 males. Results indicate that both illness and severity of illness impact upon adherence behaviour reporting. The psychosocial factors that are related to reported adherence are social support (p < 0.05), health beliefs (p < 0.05); health related quality of life for CF patients (p < 0.05), treatment burden (p < 0.05) and locus of control (chance) (p < 0.05). When health declines personality factors (NEO-PIR) remained stable (P > 0.05) however, their was a signiﬁcant reduction in anxiety t = 1.97, (p < 0.03). Conclusion: Adherence behaviour is complex and is subject to speciﬁc biases. The health of patients (inpatient versus outpatient) impacts upon self report responses.